Abstract 15084: Physiological and Hormonal Predictors for Blood Pressure Response after Percutaneous Transluminal Renal Angioplasty
BACKGROUNDS: Percutaneous transluminal renal angioplasty (PTRA) improves patency in atherosclerotic renal artery stenosis (ARAS). However, blood pressure (BP) improvement as primary purpose was achieved in only 20-40% of patients performed PTRA.
METHODS AND RESULTS: This study included 29 consecutive patients with ARAS detected by aortography for etiological screening of hypertension and performed staged PTRA in a single cardiovascular center from June 2010 till March 2012. Patients were categorized as ‘responders’ depending on mean BP decrease more than 10 mmHg 2 days after PTRA compared to baseline. Ultrasonographic data, hormonal parameters and renal functions were also evaluated at the same time points. As results, although there was no significant difference in BP at baseline between responders and non-responders (systolic, 150±21 vs. 141±18, p=0.21; diastolic, 75±13 vs. 65±12, p=0.061; mean, 100±14 vs. 91±12 mmHg, p=0.070, respectively), 14 responders achieved 21±9.0 mmHg decrease in mean BP, did 15 non-responders only 0.5±8.5 mmHg (p>0.01). On clinical backgrounds and initial medication, there also was no statistical difference. In terms of echorenographic parameters, the average value of peak systolic velocity (PSV) was significantly higher (218±95 vs. 160±41 cm/sec., p=0.039) and resistive index was significantly lower (0.78±0.05 vs. 0.84±0.07, p>0.01) in responders. Interestingly, renal/aorta ratio or acceleration time did not reach statistical significance between the groups. Assessment of hormonal parameters revealed that the concentration of serum aldosterone at baseline was significantly higher in responders (111±66 vs. 65±42 ng/dL, p=0.032), yet other parameters including plasma renin activity and serum BNP did not differ statistically between the groups. Moreover, renal function evaluated by serum creatinine, estimated GFR and cystatin C did not exhibit any significant difference between responders and non-responders.
CONCLUSION: The present study demonstrated that one physiological (PSV) and one hormonal (aldosterone) parameters were preoperative predictors of favorable BP response to PTRA. These findings may help clinicians to optimize risk-benefit profile of PTRA and reduce unnecessary intervention.
- © 2012 by American Heart Association, Inc.